Sciatica is a catch-all term that simply indicates that a patient has pain down the back of their leg and truly does not indicate a diagnosis or cause for the pain.

Common causes of sciatica include:

Disc bulge or herniation, which is at the L4 or L5 disc causing inflammation, puts pressure on the nerve root and causes pain to radiate into the buttock, back of thigh and or leg.

Piriformis syndrome, which is tightness of the hip muscles in the buttock that is responsible for turning your hip out which causes it to become tight and put pressure on the sciatic nerve that runs underneath the piriformis muscle.

Degenerative Disc Disease, which is in the lumbar spine which causes narrowing of the spinal canal and causes irritation of the nerves that make up the sciatic nerve.

Facet arthrosis, in the lumbar spine, which is a narrowing of the hole as the spinal nerve roots exit the spine and causes compression of the nerves that make up the sciatic nerve.

Spinal tumor, which can put pressure on the nerve roots.

It is extremely important to get assessed as each condition requires very specific treatment and exercises to help alleviate and rehabilitate the pain from the sciatica. In order for your doctor, chiropractor or physiotherapist to arrive at an accurate diagnosis, make a note of the following:

Was there a history of trauma?

Is your sciatica relieved or aggravated with bending forward?

Is your sciatica relieved or aggravated with bending extension?

Is your sciatica relieved or aggravated with sitting?

Is your sciatica aggravated with coughing or sneezing?

Do you have any loss of sensation or weakness in your leg?

Do anti-inflammatories help you with your pain?

Sciatica is a medical emergency if you have any of the following signs or symptoms:

Bowel or bladder incontinence.

Saddle parasthesia – which is numbness around your groin.

Unexplained weight loss.

Pain that constantly wakes you up at night and is not relieved with lying down.

Unexplained fever with back pain.

Swelling and redness along the spine.

The pain is getting worse and is sever.

You have had the pain for 4 weeks or longer that is not responding to treatment.

Sciatica treatment can consist of any one or more of the following:

Manual therapy to help assist with healing of the nerve roots where there is irritation from the tissues, and increase spinal motion of joint dysfunction.

Exercise in positions that alleviate the pain and general exercise to increase core stability and muscular endurance and strength.

I have a question, though. Under Treatments for Sciatica, you mention “manual therapy” to treat nerve root impingements, but not for piriformis syndrome. It sounds as if your reference to manual therapy is more along the lines of spinal adjustments directly applied to the vertebrae, and not much in the way of hands-on pressure (similar to massage, but not quite) for spinal muscles or piriformis. Is that true?

In my 30 years experience, many Client’s receive significant to complete relief from various sciatica symptoms by releasing muscle tensions not just in the piriformis, but also in the other gluteal muscles, such as gluteus medius and minimus. Or further down in the hamstring or even calf muscles. It does take some time to figure out which are the offending muscles in any particular Client, but it seems worth the trouble to get such quick and non-invasive relief.

In some people, although less frequently, relaxing of tensions in the abdominal wall or psoas muscles help relieve sciatic pain, too.

So, why do you appear to leave hands-on bodywork off the list? Many people have gotten much or complete relief from such. And even D.C.s Ray Nimmo and James Vannerson, as far back into the 1950s & 60s, were telling chiropractors they needed to deal more with the soft tissues. And they backed it up with significant amounts of well-accpeted scientific theory, as well.

I agree that more typical massage, as in Swedish style, has little long term affect for all but the most superficial of such issues. But manual therapies in which steady, hands-on pressure (preferably NOT to the depth of causing pain, like deep tissue which can hurt way too much) is applied to the offending muscles for many minutes at a time (with no back & forth or side-to-side movement) will frequently relieve such symptoms for very long periods of time, sometimes for good. Or, hands-on work to initiate the tension release process, then followed up with Client stretching, can work wonders. And I was one of those people myself.

You are absolutely correct in your approach. When we mentioned the term “manual therapy” we were utilizing the term to describe an all-encompassing approach that consists of (body work, soft-tissue therapy, massage, mobilization, fascial release, manipulation, active release techniques (ART), etc.). Due to the nature of our audience we kept it simple to ensure that people sought a therapist that does manual therapy.

If you are going to treat sciatica and prevent its recurrence then you must incorporate all of the approaches you have described. The majority of our treatments are based on releasing the nerves (motor and sensory) from the muscles and fascia. A new approach is also based on dermoneuromodulation as well.

The power of the brain in allowing those tissues to relax by stimulating the sensory system has profound affects and then one must retrain the brain through proper movement. A five phase approach in rehabilitation from corrective exercises to stabilization, endurance, strength and functional power movements is also crucial to prevent recurrence and target all the tissues that you have described.

We appreciate your feedback and input which is extremely valuable to help educate our followers.